u/Comfortable-Bird29

TLDR at the bottom.

Context: least paid ER in my city, level 1 trauma, 80% floor staff is travel RNs, department is in the middle of a mass exit We have a union & I'm core staff, and we have safe harbor. They are using the excuse of "orientees are extra hands"

Trauma has frequently had 15:3, and we're lucky if we have a 50:2 for our lobby. We're in the middle of the eye of the storm situation where this is our lower census time of month and we're going to hit a HEAVY upswing with past trends of 90+ in the lobby holding well into the 30s for admits. Our quick turn area has frequently been used to 'stablize' resus patients who have the potential for a room vs going back to resus. Keep in mind we have ONE cardiac monitor for this area. Of course we've been breaching our protocol for patient treatment vs what our management wants. Recently we had someone die in our lobby and just a couple days ago and orientee who was being used as a functional floor staff medicated the wrong patient with a controlled substance because his preceptor was being used for THREE ROLES.

We've had several security/safety incidents including violent patients not getting wanded down and have weapons still on them. Random people have been getting into the department found wandering around some how getting into locked areas. Btw we also have a horrible issue staffing our security department.

What started all of this: Management sent out email threatening to write up and cut contracts if found eating at desk. Travel nurse sent an email asking how were supposed to cover each other for lunch when we are always well below crit staff levels. For my department full staff is 26 RN, 19 is crit and we've been frequently running at 13-15. Management didn't respond. About 3 wks later I sent out an email piggybacked on that reply all thread. An assault happened from a family member of a patient, they were not forced to leave, our staffing is getting worse and worse. My email has gotten me referred to as "The Margaret" on my unit. 3 pages of professional written STFU, show up and see how bad it is, staff us, we're unsafe and you're doing NOTHING.

Emergency department meeting set up following week. That meeting was filled with nothing but BS lies and all talk, no game "of course we support you". They clearly were trying to find small problems they could fix to shut this down. Of course our union reps were there. We're actively losing more travelers and we're expected to be at NEGATIVE 19 nurses by the end of September with no clear plan of action other than "'We're trying to hire people." I've also been told from multiple travelers that their recruiters are actively pushing them to not renew contracts and some have even cut early at their recommendation.

I've been sitting behind the scenes quietly. Collecting info and anonymous quotes from staff because of fear of retaliation. They even asked me to "spearhead" a shared governance since I was so "passionate". So they want me to come in for more hours while I'm picking up 2 on call shifts a week to help staff the floor? I CACKLED. Even our night charges are picking up insane OT on the floor to help, on top of taking assignments during their charge shifts.

A few weeks go by and a different travel nurse sends an email to the entire department continuing to point out just how bad our staffing is and how nothing is being done. She gets pulled into the office and told that her email is creating a divide between staff and management. (No one on nightshift even knows who our management is). Her husband files safe harbor paperwork (which states you must call it ASAP, but paperwork doesn't have to be turned in until before the end of your shift) they told him that it was inappropriate to file the paperwork since they had 'fixed' the problem. He had a 7:1 ratio in our locked psych unit, and the other nurse had a 6:1, the excuse was "it's fine you have an orientee" help didn't arrive until after 11am. He got told that this kind of behavior is that of nurses who are burned out. They both were threatened to have their contracts cut for newly found problems. So of course they're going to their company to find out their retaliation options.

The travelers who were willing to speak up, are now finding themselves in the office for minute infractions that have magically shown up.

I'm trying to tread EXTREMLY lightly here and play some 4d chess here.

TLDR: Extremely unsafe staffing conditions, retaliation for staff who speak up is happening behind the scenes by finding minute loopholes, major safety issues and mass turnover.

Has anyone else had to deal with this stuff? If so how did you go about it and what are steps you took? I have a few exit plans in place and are well out of the reach of my management so even if they try to black list me from the other hospitals in our area, it won't matter.

Between the braces and the double jaw surgery, it's really been one thing after another. My orthodontist and surgeon never talked, I was expected to be the go between before and after surgery. Which lead to damaging my tmj on the right side after 5 years of braces to correct it, one yawn and because of incorrect placement of rubberbands by my orthodontist it's back to square one. Its dislocated a handful of times since then.

The orthodontists office didn't explain the different types of retainers at all. There was zero discussion as to why I should not have the plastic ones (too much plastic over the teeth causes the tmj's to slip... So more movement on an already messed up joint.) its causing nerve pain that shoots up into my skull in lightning flashes and feels like I'm crunching on a peanut. The secretary of that office was telling me that the jaw slippage is normal... Sure Jennifer, but it's BAD FOR ME. A person who has zero insight into my case is giving medical advice.

The screw for the plates on the R side of my face at my nose are coming out, so per the surgeon he said they NEED to come out. Just called his office and she told me it was going to be 3k. EXCUSE ME!? I'd been reporting that it was coming out since month one. No she's wrong. Just decided to not read my chart and try to charge me for the (not considered elective/cosmetic) procedure.

Not to mention the fiasco with the insurance. The doctor is in network. (Literally the only one in my entire state who could perform the surgery I needed.) But because the insurance doesn't like the hospital he's contracted through they're trying to charge me out of network prices for the hospital. I've appealed it several times and only one ever got filed correctly. So fed up with our insurance system. Its such shit. #luigiwaswithmehedidntdoit

I'm not sure why I bothered with any of this at this point. I've been eating soft foods for nearly a year at this point but, "Yay I have straight teeth." 😒🥴🫩

This is only meant to be a vent 😅

Just for reference I'll be 35, Anne is 28 and Kylie is going to be 31. Anne and Kylie are travel nurses and have been at my home hospital for a out 6 months now. They're getting ready to move onto their next place, Kylie has a birthday coming up and really wanted us to all have a weekend so we could do something together.

The three of us sit down and put our schedules together so we can try and maximize the amount of time we get to hang out both in and out of work. Before this, completely coincidentally, Anne and my schedule have lined up the most, and Kylie has been on nearly the opposite days. So Anne and I hang out. This was NOT ok with Kylie and she sent Anne essay length texts describing how angry and hurt she was that Anne isn't going out of her way to make time for her specifically, there was never any discussion prior to make sure that schedules lined up. This got so bad between Kylie and Anne, that Kylie would sometimes avoid me at work. (Anne confided in me, venting, I pretended as if I knew nothing) We were all supposed to go on a trip to europe in the spring with a 4th friend as well, which sounds unpleasant at this point.

Fast forward a couple of weeks. We set up an entire weekend to go to a music festival because that's what Kylie wanted to do... She just msged the group chat saying she wants to go on her own trip somewhere else.

I hate people that do this. Why cry about not spending time with people, then when people go out of their way to ensure you feel included, pivot and decide to go do something else? All while never putting in the effort to ensure that THEY are available when others are. My favorite part about this whole thing is when people use things like "Mercury is in retrograde." As an excuse for their shitty behavior, lack of accountability, and refusal to fix their own problems.

Not looking for advice or what I should/shouldn't have done. Just have to get this off my chest.

Long story semi short. Let me preface with my medical background. 3yr er as EMT-I, 10yr full time/2yr PRN (nursing school) in a 911Ambulance in one of the highest call volume services in the country, 1yr rapid response, 1yr TSI RN and now 2yr back in ER all at our largest level 1 trauma center.

So PT came in 78yo HR 160s BP 220/160s EMS said benzo OD, presentation said otherwise. A&Ox0 will say random words at random times, but cant answer anything. PT is BUCK WILD and has been in 4 point restraints since he came in and has that special kind of strength. Family has zero idea what happened, zero explanation as to why they're behaving this way. NOTHING put this PT down. Got 5 of droperIdol IM from EMS, from us 2 versed IM, then 2 IV 6 morphine and then another 5 of versed. It took us forever just to get an IV used to be a serious IVDA so his veins are trash and blew the second you poked. Even our best USIV peeps couldn't get a good enough line. I managed to some how snag a 20 in the foot that we had to use for everything. QTc is prolonged and looks like he is working his way into Torsades so we gave mag. Everything took extra long since we couldn't get a line. I would have preferred him just getting tubed but they wanted to avoid it so it is what it is.

Here's a tad bit of what else happened tonight. (Btw this is in our locked psych unit in the ED) I had 2 corrections officers deem it appropriate for them to remove restraints on a patient. I had a security guard think it was funny to purposefully piss off a patient to the point where the other guards present wrote formal complaints and requested I do the same.

PER MDs and PA I was instructed to keep the stimuli of the PT to absolute minimum. Including- I hate this however due to pt condition and agitation it is what it is- they were incontinent of urine, anytime we had to draw blood, or do ANYTHING his HR would shoot back up into 160s, never went below 130 BP never improved and only worsened. So we were absolutely concerned for worsening cardiac problems. So the decision was made to leave the patient be until we could get him down. Again I didn't like this but he was only getting worse and we were desperate for the CT. I will also reiterate that I think we should have tubed him much earlier, I only had him for the last couple hours of shift as well. The two other RNs also agreed this was in the patients best interest.

Once he was finally at 130 for more than 5 minutes the tech and I ran in to throw dry chucks under him to get him off the urine soaked bed. The day time sitter came in and told me "There's absolutely zero excuse for leaving a patient like that!." I LOST IT internally. Externally in a calm voice I let her know exactly everything I've explained here and how she has zero idea as to what is actually going on with the patient, I appreciate her concern for the patient however I've been working my butt off doing everything I could to manage them and she needed to work on her delivery of her concern since she does not know anything about the patients condition."

I refuse to let my patients sit in pee/poop even EMS sheets. As soon as I have the opportunity I make sure they get cleaned up. So to have someone who has zero understanding of the patients situation treat me as if I'm some sort of nurse ratchet because yes they sat in their pee for a couple of hours. Sorry, since the docs wanted to avoid intubating him (our ICUs are overflowing), there's only so much I can do. Stay in your lane unless you are willing to ask questions before deciding right vs wrong. Nothing is ever black or white, and if you weren't there, you can't fully understand why things happened the way they did.

BTW during report to day shift PT got moved to our resus area and tubed... 😬

Rant over, thanks for listening to my Ted talk.

I'm sure this probably doesn't come across this way for everyone. I'm assuming it's because I've done EMS/ER for fifteen years.

We are wayyyyy more fucked up, blunt, and diabolical than the two protrayed "seasoned" nurses. We will make such horrible jokes that would make any 'normal' people gasp and clutch their pearls. Guy got run over by a car? His name is now ground beef, and the cow jokes will be relentless.

We would also NEVER lie to the new kid, we will let you know what a typical night is, and then we will tell you about our absolute worst, the ones where you got your ass handed to you so hard youd be begging God for a new asshole. Then we'd tell you about the nights that REALLY fucked us up, those aren't the traumas it's the stories behind it.

We have to make sure you can handle it. Not dance around your feelings. That's what after shift breakfast drinks are for.

But really this entire scene gave me icky Greys Anatomy vibes. (For the poor medicine, not the drama.)

What other scenes in books give you this same feeling?